The use of electronic medical records (EMRs) has increased dramatically over the last 15 years. However, psychiatry has lagged. EMRs are not being used by many mental health professionals. There are many reasons, including financial burden, lack of technological support, stigma, disaggregation of upfront costs, indirect benefits, and concerns about privacy and Health Insurance Portability and Accountability Act compliance. Obtaining paper records is a lengthy process, making continuity of care and emergency care challenging. Even when records are made available, it is common for information to be incomplete. The objective of this article is to highlight how the continued use of paper charts may decrease the quality and timeliness of psychiatric care provided and to discuss the psychiatry-specific issues created by EMRs. A case illustrating the disruption of care by continued use of paper charts in psychiatric facilities is presented. The growing use of EMR creates new challenges that affect psychiatry in ways other fields are not affected. These challenges include confidentiality issues, the frequent change/spectrum of diagnoses, determining how much information should be recorded in a note, and what the implications are of the information recorded. This article will discuss the use of EMRs in psychiatry, as well as encourage medical students and residents to take a deeper dive into psychiatry-specific issues regarding the use of EMR. EMR use may have a profound impact on our patient outcomes, health care delivery system, shorter inpatient stay, as well as reduce health care costs.
Background:
Misdiagnosis in Cervical Artery Dissection (CAD) is thought to be uncommon but presenting symptoms and risk factors for misdiagnosis are not well defined.
Methods:
A nested cohort of patients with acute nontraumatic CAD were identified from a single center (2015-2021). Patients with CAD originally misdiagnosed (visiting a medical provider within 30 days for symptoms related to CAD without diagnosis of CAD) were compared against those diagnosed at presentation using descriptive statistics and unadjusted logistic regression.
Results:
Of the 52 included patients, 25 (48%) had a stroke at diagnosis, and 14 (27%) were misdiagnosed as non-CAD. Patients misdiagnosed had less severe pre-existing disability (median modified Rankin Scale and interquartile range [IQR], 0 [0-1] vs. 1 [0-1]) and were non-significantly younger (median 45 [35-68] vs. 53 [40-65], p=0.35). There was no difference in the distribution of vascular risk factors between groups. The most common presenting symptoms in misdiagnosed patients, such as focal deficits (43% vs. 42%, p=0.96) and headache (36% vs. 21%, p=0.78) were not associated with misdiagnosis. Less frequent symptoms like Horner’s syndrome (21% vs. 5%, p=0.11), neck pain (21% vs. 8%, p=0.33), and dizziness (14% vs. 5%, p=0.29) were non-significantly more common among patients with misdiagnoses.
Conclusions:
One-quarter of patients with nontraumatic CAD were misdiagnosed at first presentation. Misdiagnoses may be more common in younger persons with less pre-existing disability, and those with nonspecific symptoms such as dizziness and neck pain. Larger studies are needed to provide more precision in estimates of association.
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